A 48-year-old man (150 cm, 45 kg) who complained of intractable right lateral chest pain (T6 to T7 dermatomal segments) was hospitalized. Relationship of pain and digestion (oral intake), and time in a day, were variable. The character of pain was “throbbing”. No abnormalities were shown in his chest CT, chest X-ray, abdominal CT, abdominal ultrasonography, rib X-ray. He didn’t have gastroesophageal reflux either. As neither pentazocine nor buprenorphine was able to relieve the pain, the patient was referred from gastroenterology department to our department.
An epidural catheter was inserted at the T6-7 interspace. A continuous infusion of 2 ml of 0.125 % bupivacaine was utilized with bolus dose of 2 ml of 0.25 % bupivacaine for pain control. Effective area of epidural anesthesia was not determined, but epidural block relieved his pain. Results of further investigations using spinal magnetic resonance imaging, intravenous pyelography, renal CT, cardiac enzyme determination were within their normal ranges.
The patient vomited four days after epidural catheterization, and one of the authors was called to see the patient. He had been considering upper GI endoscopy on his way to see the patient, but the patient requested it by himself. The character of pain was changing from “throbbing” to “stabbing or stinging”.
The endoscopy revealed a duodenal ulcer and so the patient was moved to the gastroenterology ward. Omeprazole (proton pump inhibitor) 20 mg daily (orally, once a day) and sucralfate (mucosal protective) 3 g daily (orally, three times a day) were prescribed for 2 weeks. This treatment relieved the patient’s symptoms of chest pain, together with providing the cure for the duodenal ulcer. Fourteen days after commencing the treatment, the patient was discharged and followed as an outpatient for recovery.